Friday, July 27, 2018

On its face, registering individuals who have committed sexual offenses seems like common sense. It neatly ties to public perceptions and myths around these individuals, their rates of recidivism, and levels of risk. The creation of a registry reinforces risk management procedures, public protection policies, and an increasing “audit culture” (one in which there is an ever-increasing focus on monitoring and supervision) within the criminal justice system. It can seem that we are all better protected from sexual abuse when we are constantly monitoring our known sex offenders in the community, although the evidence for this is presently lacking.

The notion that focusing on the small number of people who have been brought to the attention of law enforcement, charged, convicted, and then mandated to register, while ignoring the larger community where sexual victimization occurs every day, is a clear indication that, as a society, we are not actually focusing on risk. Rather, we are making the erroneous assumption that reactive focus of registration is a better, more effective, policy that proactive prevention. This is not the only collateral consequence or contradiction of registries.

There are numerous inherent contradictions – paradoxes – that go hand in hand with developing a register. For example, by feeding myths about the inability of people who have sexually abused to change and the importance of prioritizing an audit culture, professionals and lay people alike can overlook what is actually known to reduce risk and harm. We argue that it is vital to examine the collateral damage caused by policies seemingly steeped in common sense. Doing so may force us to ask if the registry (especially in its current form) is actually fit for the combined purpose of public safety and community (re)integration.

The unfortunate and often unintended messages from the registration of people who have sexually abused include those that are:

-Anti-rehabilitation: The basic premise of the register is that the police and criminal justice system will have information on known offenders so that if, and potentially when, someone reoffends, law enforcement will know where to find them. This suggests that people don’t change; that once someone is labelled an offender that they will always be an offender. This goes against the basic tenants of treatment/rehabilitation and enables the individual to disengage from the process. Even the most stringent studies of rehabilitative efforts find a larger effect of treatment on recidivism than the registry.

-Anti-desistence: The register reinforces in people that they will always be a risk and always likely to re-offend, which impacts on their motivation to change and to desist. The inherent message is that they can never be more than the sum of their worst behaviors.

-Impede the (re)integration of individuals convicted of a sexual offence: There are many unknown and unplanned outcomes of registration for the person on the register, from the sharing of their personal data to where they can live, work and how they can access the internet. This disconnects people from their communities, impeded reintegration.

-Enforces myths about sexual abuse perpetration: The creation of registries enforces the idea that sexual abuse is perpetrated by a small group of individuals who continually reoffend. The reality, however, is that most individuals who sexually offend are not known to the police and do not have a prior offence at time of arrest.

Despite these concerns and the lack of meaningful supportive evidence, registries have been implemented internationally over the past 15-20 years and they are often seen as good practice in sex offender risk management. There has been virtually no mention in the professional literature of how rehabilitation and registration can work together, or if that is possible. Most western and northern hemisphere countries have a sex offender registry. However, there are variants in the structure and function of these registries. For example, some registries are available only to the police, some only target certain sexual offenses, and some target non-sexual offenses. Registration is the only common denominator.

The USA is an extreme example. The country is fast approaching one million people on the public registry. The USA asks for the most information, sharing much of it publicly. Even the penalties for non-compliance are extreme. Interestingly, countries looking to develop their own registers have looked to the USA as an example, though none has directly replicated it.

The policing and risk management function of the register may have merit, but it is time to reconceptualize it and reconsider the underlying premise to make sure that it is a prosocial, positive risk management tool. As for the USA, there is little room to argue that the registry, in its current form, is prosocial or positive.

When asked, most lay people believe that providing rehabilitative services to people who have committed sexual crimes is one of many good ideas. Given that the registry is likely here to stay, it’s time to consider how we can also promote policies that are going to have a demonstrable impact on public safety.

Kieran McCartan, PhD, Professor, University of the West of
England-Bristol

(*Both teams located within Practice Connect under the Queensland Department
of Child Safety, Youth, and Women).

The #metoo movement has been called a watershed moment in the way that
we think about, respond to, and prevent sexual abuse and harassment. People are
talking, which is fabulous. We want people to talk, but language matters, and
we need to use the right words.

The Weinstein “event” has led to an increasing number of “brave men and
women” coming forth to share their stories. Those stories have been
differentially described as revelations, allegations, accusations, disclosures,
and delusions. Similarly, the responses by those alleged to have abused have
included denials, excuses, justifications, apologies, lies, and responsibility
taking. Individuals have been named, shamed, fired, silenced, and “tried by
twitter.”

Talking heads are now engaging in nuanced public discussions about the
difference between sexual abuse, sexual assault, sexual exploitation, and
sexual harassment. These are not the same thing, they do not have the same
consequences, or carry the same penalties, and should not be viewed similarly.
We have discussed the semantics of sexual abuse, harassment and the #metoo
movement on the ATSA blog before. Here, we consider the specific phrase of “sexual
harm.” It is challenging to expect members of the public or non-related
professions to understand as well as use terminology correctly when even those
in the field struggle with language.

We acknowledge the need to use person first language (Willis, 2018) and are
beginning to opt for the apparently clunkier “person convicted of a sexual
offense” rather than the more pejorative “sex offender” (or worse “predator”).
As Nicole Pittman reminded us recently (ATSA conference, 2017): “they’re worth
the extra words.” As we continue to negotiate our use of language, it goes
without saying we must navigate both legislation and legal jargon as it is used
across numerous jurisdictions in multiple countries but also the most sensitive
of topics where euphemisms are rife.

ATSA is an international community. Many of us work and travel abroad
often. One can always get mileage out of
the flip flop/thong/g-string situation. Since returning to Australia for
example, Danielle has had to relearn the language—both legal and practical—to
engage in respectful discourse. It was during this process that she came to
learn of the challenges and, in some sectors, very strong views about the use
of the phrase “sexual harm.”

“Sexual harm” is frequently used as a catchall phrase intended to include
various types of violence, abuse, assault, and harm that results from sexual
abuse or violence of a sexual nature. The idea of harm—as opposed to other
language (i.e., abuse, trauma, etc.)—comes from the field of Zemiology, based
on the idea that “harm” is more proactive and adaptive than other terms. It is
thought that it is therefore more helpful for people who have experienced
sexual abuse or assault and people who have sexually abused others and/or
committed sexual offences to move on. However, the word “harm” is divisive in
the field of sexual abuse, especially from the perspectives of criminal justice
and victim advocacy groups who argue that “harm” lessens the impact and consequences
of exactly what a person experiences as a result of sexual abuse.

According to the Queensland Department of Child Safety, Youth, and Women,
the harm that a person experiences as a result of sexual abuse is either:

(1) Emotional/psychological harm,

(2) Physical harm or,

(3) Both emotional/psychological and physical harm.

By way of example,

-If a 16 year old girl reports to her Child Safety Officer that her arm
was broken three years ago during an argument with her stepfather, she would be
referred to a medical practitioner to ensure that the arm was set properly and
the break has healed (thus treating the physical harm) and would likely also be
referred to a counsellor to attend to the emotional stress and trauma caused by
the same incident (thus treating the psychological harm).

-If a 16 year old girl reports to her Child Safety Officer that she was
vaginally penetrated three years ago by her stepfather, she should similarly be
referred to a medical practitioner for an internal exam to ensure that there is
no lasting damage, that her vagina has healed (thus treating the physical harm)
and would also be referred to a counsellor to attend to the emotional stress
and trauma caused by the same incident (thus treating the psychological harm).

Basically, if we understand the harm to be physical then we can target
our intervention to the physical harm. Examples include getting medical
treatment for damage to the child’s genitals or anus, or diagnosis and
appropriate medication for the sexually transmitted infection that the child
has contracted.

Likewise, if we understand the harm to be emotional then we can target
our intervention to the emotional harm. Examples here include providing counselling
to help the child understand that it was not their fault that the sexual abuse happened
to them; or offering assistance that might also focus on the potential risk
that the young person poses to others, including safety planning and
counselling.

To be clear, “sexual violence” describes the behaviour that someone is
responsible for committing. The “harm” is the resulting impact on the person
who has experienced the sexual violence. Quite simply, when someone experiences
violence, their resulting physical harm can be treated by a medical doctor and
their resulting emotional harm can be treated by a counsellor. The challenge
with the use of the phrase “sexual harm” is that it can lead to confusion over
how best to help the actual harm that
the person has experienced. By observing the presence of the resulting physical
and emotional harm that results from
the commission of sexual violence we can offer a clear direction for
interventions that best cater to the needs of the individual and the actual
harm they have experienced.

Friday, July 13, 2018

I work with adolescents who have
engaged in problematic sexual behavior. Many of the clients with whom I work
are males. Being that within our juvenile justice system there is an
over-representation of those who come from marginalized communities, specifically
Black and Brown ones---with many explanations for this given from
over-policing, racial profiling, poverty not permitting access to services
expect through “systems”, etc.---it is not surprising that a significant
portion of those I serve are Black. Taking into consideration that the large
majority of sexual offenses committed by juveniles are committed by males (Finkelhor, Ormrod, & Chaffin, 2009)
it does not surprise me when clients I serve are overwhelmingly black boys, due
to a skewed engagement with the juvenile justice system.

When addressing problematic sexual
decisions with the boys I counsel, oftentimes the topic of their own early
sexual experiences emerges. In these conversations, there are times when they
report initiation to sexual behavior occurring at the hands of much older
adolescent or adult females and in some cases, male caregivers. Yet, in these discussions,
many of them do not view such interactions as sexual abuse or sexually
inappropriate, in part, because my community does not often “permit” our boys
access to the concept of it being acceptable to not want sexual contact.

Recently, Terry Crews, a
famous Black actor, came out and discussed his own #MeToo moment. He disclosed his own experiences with sexual
victimization. While some praised him, others including the Rapper 50 Cent, in
a tweet, and Senator Feinstein, in a congressional hearing, gave a response
with which I am more familiar with--- 50 Cent viewing Mr. Crews’s victimization
as discounting his manhood and Senator Feinstein questioning why a big male
such as Mr. Crews did not fight back.This toxic masculinity, which is the push towards hypermasculinity and
belief in traditional male stereotypes, is prevalent within our Black and Brown
communities in part because of the historical emasculation of Black males since
slavery into Jim Crow. The current climate which we live in continues to
downplay options for healthy development of a male identity within the Black
and Brown communities due to mass incarceration. Such ingrained
hypermasculinity impacts not only the starting point in which one engages with
Black boys related to what healthy sexual decisions look like, but also in
reframingdiscriminatory selection of
sexual partners as being empowering instead of a sign of “weakness”.

How should the knowledge of toxic
masculinity impact our work with especially Black boys who have engaged in
problematic sexual behavior?

Explore
early sexual experiences-address and normalize feelings of discomfort
around sexual contacts with those who were much older and provide them the
language to describe it as unwanted and problematic. Allow them the safe
space to process this.

Assist in
examining how they define manhood. Where did the definitions come from?
How do they inform their views of sex and sexuality? The Young
Men’s Work curriculum and the book Dare
to Be King offer great resources on beginning this discussion from a
gender and a racial context.

Reframe
masculinity as being an advocate for healthy relationships and being a
catalyst for assisting other males in doing the same.

Examine
how (if applicable) these boys own problematic sexual decisions were
informed by toxic masculinity/hypermasculinity.

When possible, engage other Black men in their lives who can serve
as a model for healthy masculinity. When not readily available, identify
movies, books, and other mediums in which there are positive portrayals of
black manhood. Interwoven in this should also be those stories of black
men and boys who have experienced victimization, struggles with their own
identifies, and other traumas---which can provide a framework for further
exploration of the impact of trauma and how it may play out uniquely for
black boys.

On June 11thNL-ATSA, the Dutch Chapter of ATSA, organized a masterclass on the assessment and treatment of sex offenders with intellectual disabilities.in conjunction with the International Forensic Mental Health Services at the IAFMHS conference 2018 in Antwerp (Belgium).

A considerable number of sex offenders exhibit intellectual disabilities (ID). These offenders require bespoke assessment, support, and treatment. However, in practice ID and its role in sexual deviant behavior are not always fully recognized nor well understood. To enhance the effectiveness of support and treatment programs for sex offenders with ID, it is of great importance for professionals to be aware of the presence of the ID’s, to understand its influence on (sexual) behavior, and to have knowledge of effective treatment programs.

By organizing this masterclass, we also wanted to honor the works of Prof. William R. Lindsaywho unfortunately has passed away in March 2017. William Lindsay had dedicated his career to further our understanding of offending behavior among people with ID and to improve assessment and treatment tools in these offenders. He was mainly passionate about identifying the pathways into forensic services of ID offenders, developing adequate assessment tools and establishing effective, evidence-based treatment programs for these offenders. Notwithstanding his very busy research agenda, he also found sufficient time throughout his career to acquire extensive clinical experience with ID offenders: To honor his invaluable work, the masterclass gave ample attention to Prof. Lindsay’s research throughout all sessions. In order to ensure that in-depth insights into Prof. Lindsay’s views and work would be shared, only presenters who had collaborated with Prof. Lindsay in terms of education and/or research were included in the program.

The presenters of the first session, Prof. Kasia Uzieblo (Thomas More and Ghent University, Belgium) and Dr. Petra Habets (OPZC Rekem, Belgium), focused on the assessment of ID in offenders, a topic that even in books on (sex) offenders with ID is often being overlooked. Given the important consequences of an ID diagnosis in offenders, this observation is rather striking. There is ample evidence showing that the assessment of ID in both research and practice comprise several substantial problems and limitations and does not sufficiently adapt to significant evolutions in intelligence research. The convergent validity of the current measures for IQ (e.g., the Wechsler Scales and the Raven’s Progressive Matrices) exhibits substantial problems. For instance, a study by Habets, Jeandarme, Uzieblo, Oei, and Bogaerts (2014) showed that despite positive correlations among intelligence measures, differences between scores on repeated and different IQ measures of 10 points and more occur far too often. In addition, current intelligence measures seem to not sufficiently tap into the various intellectual abilities as described in current theoretical frameworks of intelligence, including the Cattell-Horn-Carroll Model (CHC-model). Another assessment problem arises when taking into account the second diagnostic criterion of ID, i.e. deficits in adaptive functioning. In contrast to previous editions, the fifth version of the Diagnostic and Statistical Manual for Mental Disorders as well as the upcoming 11th edition of the International Classification of Diseases (ICD-11) underline that it is not the IQ score but rather the level of adaptive functioning that determines the level of support needed. Hence, a reliable assessment of adaptive functioning on the conceptual, social and practical domain becomes of utter importance. However, adaptive functioning is often neglected in the assessment procedures or is not sufficiently taken into account when diagnosing ID. This problem might be intertwined with another issue: There is a lack of reliable, valid, and comprehensive measures for adaptive functioning. Unfortunately, this is not all. Many additional problems, including the lack of culturally fair assessment practices and the effect of comorbid psychiatric disorders on ID assessment, merit attention. In sum, Uzieblo and Habets highlighted the need for adequate, comprehensive assessment procedures for ID that align with the most recent theoretical frameworks of intelligence.

The second presenter, Prof. Leam A. Craig (University of Birmingham, UK), focused on the prevalence of ID in sex offenders, etiological explanations of sexual offending behavior in ID offenders, treatment effects, and risk assessment. Prevalence rates of sex offenders with ID typically range from 21 to 50%. However, we have no way of knowing how accurate these percentages actually are. Prof. Craig offered several etiological explanations of sexual offending in offenders with ID. Some studies on sexual abuse in people with ID suggest that behavioral problems (i.e., sexual inhibition) are a consequence of sexual abuse but not of physical abuse. Another hypothesis is that sex offenders with ID are more impulsive than their non-disabled counterparts, although findings on grooming suggest that individuals with ID do demonstrate delayed gratification. One of the most influential explanations is the counterfeit-deviance hypothesis which assumes that sexual deviant behavior is precipitated by a lack of sexual knowledge, poor social skills, limited opportunities, and sexual naivety rather than deviant sexual interests. However, several studies contradict this assumption. In sum, the developmental pathways into sexual offending in people with ID are not well understood yet. With regard to treatment programs for sex offenders with ID, CBT principles are the most commonly applied in these programs. But two problems occur. These programs are typically based on existing non-ID programs. And there is empirical support for their effectiveness. The latter is partly due to methodological problems, such as few randomized clinical trials and the fact that comparison groups are often not available. Next, Prof. Craig provided an overview of commonly used risk methodologies and instruments. Often, the same instruments are used in offenders with ID and non-ID offenders, such as the SVR-20, Static-99, and the Risk Matrix-2000. The ARMIDILLO-S is an instrument specifically developed for sex offenders with ID. Because of the extensive use of risk assessment within the management and treatment of sexual offenders with ID, the accuracy of predictions is of utmost importance. Prediction, however, remains a tricky thing. We have to be aware of what we are actually predicting. Also, the predictive value of risk offender instruments is dependent on definitions of sexual deviant behavior, sex offender ID characteristics (e.g., higher incidence of family psychopathology, behavioral disturbances at school, sexual naivety, and poor impulse control) and base rates. Given the variation in base rates and recidivism rates across risk categoriesin samples of sexual offenders with ID, it appears that it is more helpful to report relative levels of risk rather than absolute rates of recidivism.

In the final presentation, Prof. John Taylor (Northumbria University, UK) discussed several tools for practice. He specifically focused on the added value of Finkelhor’s precondition offending model as a shared multidisciplinary and valuable approach. In this approach, the motivation to sexually offend is dissected in four stages. Stage 1 focuses on aspects that influence motivation, such as sexual arousal to inappropriate stimuli and experience of abuse. Stage 2 addresses overcoming self-control. More specifically, cognitive distortions, stress, drug/alcohol abuse and organic factors may lead to disinhibition. Stage 3 emphasizes external control. For example, external factors such as social isolation, discontinuation of supervision or structure, and unusual living/sleeping arrangement may increase the risk of offending. Finally, stage 4 focuses on overcoming victim resistance. Different influencing factors may be prominent in different offenders. Based on these factors, an individualized risk management plan including the level of risk, probability of risk, clinical interventions and management strategies can be developed. In the Northgate Sex Offender Treatment Program (Northumberland, Tyne & Wear NHS Foundation Trust) patients are encouraged to work through three developmental levels over the course of 12-24 months. First (phase 1, pre-treatment group) patients are desensitized to working in a group setting. Next (phase 2, intermediate group, patients are encouraged to discuss more personal issues, emotional difficulties and other things they would like to change. Finally (phase 3, is the offence related group), patients are encouraged to consider behavior related to their offences.

Several discussions with the participants during the masterclass indicated that many practitioners are struggling with the assessment in and treatment of ID offenders. There is clearly an urgent need to share best practices and to develop evidence-based assessment and treatment tools for practice. Since Prof. Lindsay has highlighted these necessities in his first studies, this field has moved forward, mainly thanks to his work. But we are obviously not there yet, as was made very clear throughout the presentations. Hence, it is of vital importance that experts, including Leam Craig, John Taylor and many others working with ID offenders, will proceed with their invaluable work in research and practice. We should also remain working on that two-way bridge between research and practice that Prof. Lindsay had been striving for. Maybe it is utopian to think that we will ever find a solution for all the problems we encounter when working with ID offenders. But nevertheless, we should follow in the footsteps of William Lindsay, and at least aspire to reach this destination.

Kieran McCartan, PhD

Chief Blogger

David Prescott, LICSW

Associate blogger

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The Association for the Treatment of Sexual Abusers (http://atsa.com/) is an international, multi-disciplinary organization dedicated to preventing sexual abuse. Through research, education, and shared learning ATSA promotes evidence based practice, public policy and community strategies that lead to the effective assessment, treatment and management of individuals who have sexually abused or are risk to abuse.

The views expressed on this blog are of the bloggers and are not necessarily those of the Association for the Treatment of Sexual Abusers, Sexual Abuse: A Journal of Research & Treatment, or Sage Journals.

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